Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
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Split-liver transplantation is becoming a useful technique to expand the donor pool. Whether the split should be performed in situ or ex situ is not clear. One potential disadvantage of in situ splits is that prolonged surgical time and increased blood loss may negatively affect the function of other solid organs (kidneys, pancreas, and heart) procured from the same donor. ⋯ At hospital discharge, pancreas and pancreas-kidney transplant recipients were all insulin free, with good urine amylase levels, no surgical or infectious complications, and no evidence of significant pancreatitis posttransplantation. The kidney of the pancreas-kidney transplant recipient functioned immediately; creatinine level after 7 months of follow-up was 1.2 mg/dL. Despite increased surgical time and blood loss, in situ splitting of liver grafts can be accomplished in stable donors without significant negative effects on other organs.
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The aim of this uncontrolled pilot study is to determine the effect of treatment with the molecular adsorbents recirculating system (MARS) on cerebral perfusion in patients with acute on chronic liver failure (AOCLF). In 8 patients (median age, 44 years; range, 35 to 52 years) admitted with AOCLF, a single 10-hour MARS treatment was performed. Hepatic encephalopathy (HE) was graded according to the Fogarty criteria. ⋯ During MARS treatment, HE grade improved in 3 patients and remained unchanged in 5 patients (P =.11). V(mean) increased from 42 cm/sec (range, 26 to 59 cm/sec) to 72 cm/sec (range, 52 to 106 cm/sec; P <.05), whereas arterial ammonia level decreased from 88 micromol/L (range, 45 to 117 micromol/L) to 71 micromol/L (range, 26 to 98 micromol/L; P <.05) and bilirubin level from 537 micromol/L (range, 324 to 877 micromol/L) to 351 micromol/L (range, 228 to 512 micromol/L; P <.05). In conclusion, cerebral perfusion is increased and levels of ammonia and bilirubin are reduced during MARS treatment in patients with AOCLF.
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Comparative Study
Accuracy and utility of 3-dimensional computed tomography in evaluating donors for adult living related liver transplants.
Three-dimensional (3D) computed tomography (CT) is an imaging technique that renders anatomic detail in 3D images from helical computed tomographic scans. The purpose of this study is to assess 3D CT in the preoperative evaluation of adult living related liver transplant donors. Nine patients underwent right-lobe liver resection for adult living related liver transplants between October 1999 and September 2000. ⋯ The 3D computed tomographic images of hepatic and portal veins were better than or equivalent to angiograms in nearly all cases. The 3D computed tomographic images of the hepatic artery were better than or equivalent to angiography in 5 of 9 cases. By providing an accurate 3D map of the liver and its vasculature, 3D computed tomographic reconstructions of the hepatic vasculature are a useful adjunct for surgical planning in adult living related liver donors. 3D CT clearly delineates portal and hepatic veins as well as or better than the angiogram and can identify the hepatic artery and its branches well enough to consider replacing angiography, thus reducing cost, inconvenience, and risk to the donor.
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Pneumocystis carinii pneumonia (PCP) is an opportunistic infection associated with increased morbidity and mortality in solid-organ and bone-marrow transplant recipients. Side effects of trimethoprim-sulfamethoxazole (TMP/SMX) are frequent; therefore, we performed a preliminary study using atovaquone suspension, 750 mg once daily, for 1 year for the prevention of PCP in liver transplant recipients intolerant to TMP/SMX therapy. Twenty-eight patients were treated, and data were analyzed for efficacy and toxicity. ⋯ No patients developed Pneumocystis carinii infection. Although a lower dose of atovaquone once daily may be effective in transplant recipients, further studies are necessary to confirm this preliminary observation. Liver Transpl 2001;7:750-751.)